Zuo Zhenxiang, Qi Xing, Cui Xiujie, Yu Bin, Zhang Huimin, Wu Honglei
Department of Gastroenterology, the Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.
Department of Pathology, the Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.
Front Oncol. 2024 Oct 30;14:1456520. doi: 10.3389/fonc.2024.1456520. eCollection 2024.
Gastric papillary adenocarcinoma (GPA), a well-differentiated gastric adenocarcinoma, is associated with a worse prognosis compared to other differentiated gastric adenocarcinomas. Therefore, there is an urgent need to characterize its endoscopic manifestations for guiding biopsy site selection and achieving accurate diagnosis.
From January 1, 2016, to December 31, 2022, the data of 46 cases of early gastric papillary adenocarcinoma (EGPA) and 183 cases of early gastric differentiated tubular adenocarcinoma (EGDTA) diagnosed via pathological examination following endoscopic submucosal dissection (ESD) at the Second Hospital of Shandong University were collected. Propensity score matching (PSM) was employed to match 92 EGDTA patients at a ratio of 1:2, serving as the control group. Differences between the two groups were analyzed using multivariable logistic regression. Lastly, the relationship between vessels within epithelial circle (VEC) structures in EGPA and the degree of malignancy was assessed.
Compared with EGDTA, EGPA was more likely to infiltrate the submucosa, more frequently associated with poorly differentiated cancer components, and more prone to invading lymphatic and blood vessels. EGPA was primarily located in the lower stomach and manifested as a uniformly elevated pattern under endoscopy, while VEC structural positivity could be visualized under ME-NBI. Moreover, EGPA lesions had larger diameters and were characterized by high expression of gastric mucins, namely MUC5AC and MUC6. When EGPA infiltrated the submucosa or contained poorly differentiated cancer components, the VEC structures were smaller.
The present study demonstrated that EGPA exhibits a higher degree of malignancy. Endoscopic findings of a raised lesion with a uniform color under endoscopy and the presence of VEC structures under ME-NBI suggest a high possibility of EGPA. Moreover, smaller VEC structures were associated with a higher degree of malignancy, which may assist in guiding the selection of biopsy sites under endoscopy.
胃乳头状腺癌（GPA）是一种高分化胃腺癌，与其他分化型胃腺癌相比，其预后较差。因此，迫切需要明确其内镜表现，以指导活检部位的选择并实现准确诊断。
收集2016年1月1日至2022年12月31日在山东大学第二医院经内镜黏膜下剥离术（ESD）后病理检查确诊的46例早期胃乳头状腺癌（EGPA）和183例早期胃分化型管状腺癌（EGDTA）的数据。采用倾向评分匹配（PSM）以1:2的比例匹配92例EGDTA患者作为对照组。使用多变量逻辑回归分析两组之间的差异。最后，评估EGPA中上皮圈内血管（VEC）结构与恶性程度之间的关系。
与EGDTA相比，EGPA更易侵犯黏膜下层，更常伴有低分化癌成分，更容易侵犯淋巴管和血管。EGPA主要位于胃下部，内镜下表现为均匀隆起型，而在放大窄带成像（ME-NBI）下可观察到VEC结构阳性。此外，EGPA病变直径较大，具有胃黏液蛋白MUC5AC和MUC6的高表达特征。当EGPA侵犯黏膜下层或含有低分化癌成分时，VEC结构较小。
本研究表明EGPA具有较高的恶性程度。内镜下表现为颜色均匀的隆起性病变以及ME-NBI下存在VEC结构提示EGPA的可能性较大。此外，较小的VEC结构与较高的恶性程度相关，这可能有助于指导内镜下活检部位的选择。
